Provider Demographics
NPI:1265131098
Name:MALAGUERRA, SUMMER LYNN CLAVEAU (MED, BCBA LBA)
Entity type:Individual
Prefix:
First Name:SUMMER LYNN
Middle Name:CLAVEAU
Last Name:MALAGUERRA
Suffix:
Gender:F
Credentials:MED, BCBA LBA
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:LYNN
Other - Last Name:CLAVEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2320 KINGSBURY LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3015
Mailing Address - Country:US
Mailing Address - Phone:703-407-5694
Mailing Address - Fax:
Practice Address - Street 1:12531 CLIPPER DR STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2355
Practice Address - Country:US
Practice Address - Phone:571-404-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002460103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst